DCF方案治疗晚期胃癌患者的临床分析

目的:观察DCF方案治疗局部进展期或转移性胃癌的疗效和不良反应。方法:自2007年10月至2009年8月,42例晚期胃癌患者采用DCF,DXT(多西紫杉醇)75mg/m2,静脉滴注,第1天;DDP(顺铂)25 mg/m2,第1-3天;CF(亚叶酸钙)200mg/d,静脉滴注2小时,第1-5天;5-FU(氟尿嘧啶)500mg/m2,第1-5天,静脉滴注5-6小时,3周为1周期,方案治疗,按WHO标准评价近期疗效和不良反应,随访疾病进展时间(TTP)和中位生存期(MST)。结果:全组42例均可评价疗效,其中CR 3例,PR 19例,SD 11例,PD 9例。有效率(RR)为54.7%,中位TTP为5.5个月,中位MST为10个月。不良反应主要是骨髓抑制及胃肠道反应,其次为口腔黏膜炎、腹泻及周围神经毒性。结论:DCF方案治疗晚期胃癌的疗效较好,不良反应可以耐受。     

Epidural anesthesia may attenuate lipid peroxidation during aorto-femoral surgery

PURPOSE: To determine the effect of epidural anesthesia (EP) on oxygenation of the chronically ischemic limb in patients undergoing aorto-femoral bypass grafting and to assess whether it produces an alteration of lipid peroxidation and antioxidant status following revascularization. METHODS: In this prospective, randomized, single-blinded study 40 ASA II or III patients undergoing elective aorto-femoral bypass grafting were allocated to receive general anesthesia (group GA, n = 20), or epidural + GA (group EP, n = 20) during surgery. Femoral venous blood-gas status, activities of the protecting antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GSH-px), glutathione reductase (GSH-rd), glutathione (GSH) and thiobarbituric acid-reactive substances (TBARS) as a marker of lipid peroxidation were determined in blood samples taken from the femoral vein at different intervals before and after revascularization. RESULTS: Before the induction of anesthesia in group EP, femoral venous PO(2) [mean (standard deviation), 95% confidence interval] increased after achieving an adequate level of blockade by EP extending to the dermatomal level of T6-8 [29.32 (4.6), 26.34-32.30 to 36.29 (4.6), 33.37-39.22 mmHg, P < 0.05]. Femoral venous PO(2) was similar in both groups thereafter. In the GA group a significant increase in erythrocyte TBARS was observed immediately after restoration of blood flow when compared with baseline values [221.32 (102), 148.35-294-29 to 337.26 (123) 248.99-425.53 nmol*g(-1) hemoglobin, P < 0.01] but not at any other moment. In the EP group TBARS did not increase throughout the study. Within group comparisons revealed no significant differences in GSH, GSH-px, GSH-rd and SOD. CONCLUSION: In patients with atherosclerotic aorto-iliac occlusive disease EP may possibly attenuate lipid peroxidation following revascularization but has no effect on antioxidant enzyme activities.     

The impact of depression and ghrelin on body weight in migraineurs

Background

Comorbidity of migraine with anxiety and depression may play a role in the link between migraine and obesity. We examined the moderating and mediating roles of ghrelin in the relationship between depression (and anxiety) and body weight in newly diagnosed migraineurs.

Methods

Participants were 63 newly diagnosed migraine patients (using the ICHD-II criteria) and 42 healthy volunteers. Body mass index (BMI) was calculated by measuring height and weight. Ghrelin was assessed at fasting. Depression was assessed with the Hamilton Depression scale, and anxiety with the Hamilton Anxiety scale.

Results

The data did not support the mediating role of ghrelin in the relationship between depression (or anxiety) and BMI for either the migraine or the control group. The interaction between ghrelin and depression as well as anxiety was significant for the migraine group, but not for the control group. Depressed (or anxious) migraineurs had a positive association between ghrelin and BMI, whereas for the non-depressed (or non-anxious) migraineurs this association was negative.

Conclusions

Depression and anxiety moderated the effect of ghrelin on BMI for migraineurs. Management of anxiety and depression might be regarded as part of migraine treatment.     

Plasma leptin and its relationship with lipid peroxidation and nitric oxide in obese female patients with or without hypertension

BACKGROUND: Recent evidence suggested that leptin-induced oxidative stress in human endothelial cells in vivo and increased oxidative stress in human essential hypertension may further contribute to both the development of atherosclerosis and other cardiovascular diseases. We investigated the association of plasma leptin levels with plasma lipid peroxidation and nitric oxide metabolites (NOx) in obese hypertensive atherosclerosis model. METHODS: Plasma leptin, lipid peroxidation and NOx levels were determined in age-matched non-obese normotensive female subjects (n = 30), obese normotensive female subjects (n = 45), and obese hypertensive female subjects (n = 50). Plasma leptin levels were determined by immunoradiometric method. Lipid peroxidation was determined as thiobarbituric acid reactive substances (TBARS) using spectrophotometric method. NOx levels were determined using enzymatic method. RESULTS: We found that plasma leptin and TBARS levels were increased in obesity, and obese hypertensives have significantly higher plasma leptin and TBARS levels than obese normotensives (p <0.001 and p <0.001). Obese hypertensives have significantly lower plasma NOx levels than obese normotensives (p <0.001). In univariate and multivariate regression analysis, plasma leptin levels were significantly correlated with TBARS (p <0.01 and p <0.01) in obese subjects. Plasma TBARS were also inversely correlated with NOx in hypertensive obese subjects (r = -0.412, p <0.01). CONCLUSIONS: Our results have shown that elevated leptin levels may be associated with increased oxidative stress and free-radical-induced decreased NOx levels. Therefore, hyperleptinemia may be an important contributor to the generation of hypertension in obesity.     

Plasma Adhesion and Inflammation Markers: Asymmetrical Dimethyl-L-Arginine and Secretory Phospholipase A<Subscript>2</Subscript> Concentrations before and after Laparoscopic Gastric Banding in Morbidly Obese Patients

Background The aim of this study was to examine the relationship between subclinical inflammation and weight loss by laparoscopic adjustable gastric banding (LAGB). Methods Plasma concentrations of intercellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1), sensitive C-Reactive Protein (sCRP), asymmetrical dimethyl-L-arginine (ADMA), Secretory Phospholipase A2 (sPLA2), and metabolic markers, such as homeostatic model assessment – insulin resistance (HOMA-IR) and body mass index (BMI) were determined in morbidly obese patients (n = 18, BMI 48.6 ± 1.7 kg/m²) at baseline and 1 month after operations. Baseline levels in patients were also compared with age-matched controls (n = 20, BMI 21.3 ± 1.8 kg/m²). Plasma ICAM-1,VCAM, sCRP and ADMA, and sPLA₂ concentrations were determined by enzyme-linked immunoassay methods and colorimetric method, respectively. Results Plasma sCRP, ICAM-1, ADMA and sPLA₂ concentrations and HOMA-IR were significantly higher in morbidly obese patients than in controls (for each, P < 0.01). Plasma VCAM-1 concentration was not changed in obese patients. HOMA-IR was significantly correlated with ICAM-1, ADMA and sPLA₂ in the obese group at baseline (for each, P < 0.01). There was a significant correlation between plasma sCRP and plasma glucose,VCAM-1, ICAM-1, ADMA and sPLA₂ concentrations (for each, P < 0.01). 1 month after LAGB, mean body weight loss was 13.2 ± 6.3 kg, and plasma sCRP and ADMA concentrations and HOMA-IR and BMI were significantly decreased (for each, P < 0.01). However, these levels cannot be decreased to the levels of the controls. Conclusion Obesity and insulin resistance appear to be associated with low-grade inflammation and endothelial dysfunction. Insulin resistance and endothelial dysfunction were improved by weight loss after LAGB.     

Serum brain-derived neurotrophic factor, nerve growth factor and neurotrophin-3 levels in dementia

The aim of this study is to measure serum levels of neurotropic factor (NF) in patients with dementia. Brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and neurotrophin-3 (NT-3) were determined in Alzheimer's dementia patients without medication (AD; n: 22), Alzheimer's dementia patients receiving cholinesterase inhibitor (CEI) treatment (AD?+?CEI; n: 32) and vascular dementia patients receiving CEI treatment (VaD?+?CEI; n: 27) and the age-matched control group (n: 20). NGF levels were detected to be significantly higher in the control group than in AD group (P?相似文献   

The Incidence of and Factors Associated with Vitamin D Deficiency in Newly Diagnosed Children with Cancer

This retrospective chart review study aimed to assess vitamin D status and identify risk factors associated with vitamin D deficiency and bone parameters in children with cancer at admission. The data of 86 (50 males and 36 females) patients between April 2013 and June 2015 were analyzed. Calcium, phosphorus, alkaline phosphatase (ALP), 25(OH)D, age, gender, diagnostic category, body mass index, duration of complaints, and season of blood sampling were recorded. Median age was 7.17 years (range 0.31—17.40) in 29 hematological malignancy and 57 solid tumor patients. According to cut-off level of 20 ng/ml, 63% of children with cancer had vitamin D deficiency at diagnosis with a median 25(OH)D of 16.75 ng/ml. The mean vitamin D value of children >10 years was significantly low in comparison to that observed in younger children [11.83, 95% confidence interval (CI) = = 8.85—14.81 ng/ml vs. 19.81, 95% CI = = 17.02—22.60 ng/ml]. Vitamin D measurement between November and May was a risk factor for vitamin D deficiency (P < 0.05). The frequency of hypocalcemia and hypophosphatemia was not different between two groups of vitamin D. Further longitudinal studies are needed to investigate whether monitoring vitamin D status and supplementation in children with cancer might prevent future complications related to vitamin D deficiency.     

Sharp Central Venous Recanalization in Hemodialysis Patients: A Single-Institution Experience

Purpose

We report our institutional experience with sharp central venous recanalization in chronic hemodialysis patients who failed standard techniques.

Materials and Methods

Since January 2014, a series of seven consecutive patients (four males and three females), mean age 35 years (18–65 years), underwent sharp central venous recanalization. Indications included obtaining hemodialysis access (n = 6) and restoration of superior vena cava (SVC) patency to alleviate occlusion symptoms and restore fistula function (n = 1). The transseptal needle was used for sharp recanalization in six patients, while it could not be introduced in one patient due to total occlusion of the inferior vena cava. Instead, transmediastinal SVC access using Chiba needle was obtained.

Results

Technical success was achieved in all cases. SVC recanalization achieved symptoms’ relief and restored fistula function in the symptomatic patient. One patient underwent arteriovenous fistula creation on the recanalized side 3 months after the procedure. The remaining catheters were functional at median follow-up time of 9 months (1–14 months). Two major complications occurred including a right hemothorax and a small hemopericardium, which were managed by covered stent placement across the perforated SVC.

Conclusion

Sharp central venous recanalization using the transseptal needle is feasible technique in patients who failed standard recanalization procedures. The potential high risk of complications necessitates thorough awareness of anatomy and proper technical preparedness.

     

Preventive effects of curcumin on different aspiration material-induced lung injury in rats

Purpose  We have studied whether curcumin protects different pulmonary aspiration material-induced lung injury in rats. Materials and methods  The experiments were designed in 60 Sprague–Dawley rats, randomly allotted into one of six groups (n = 10): normal saline (NS, control), enteral formula (Biosorb Energy Plus, BIO), hydrochloric acid (HCl), NS + curcumin-treated, BIO + curcumin-treated, and HCl + curcumin-treated. NS, BIO, HCl were injected in to the lungs. The rats received curcumin twice daily only for 7 days. Seven days later, both lungs in all groups were examined histopathologically, immunohistochemically, and biochemically. Histopathologic examination was performed according to the presence of peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation. Immunohistochemical assessments were examined for the activity of inducible nitric oxide synthase (iNOS) and the expression of surfactant protein D (SP-D). Malondialdehyde (MDA), hydroxyproline (HP), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) activity were measured in the lung tissue. Results  Our findings show that curcumin inhibits the inflammatory response reducing significantly (P < 0.05) all histopathological parameters in different pulmonary aspiration models. Pulmonary aspiration significantly increased the tissue HP content, MDA levels and decreased the antioxidant enzyme (SOD, GSH-Px) activities. Curcumin treatment significantly decreased the elevated tissue HP content, and MDA levels and prevented inhibition of SOD, and GSH-Px enzymes in the tissues. Furthermore, our data suggest that there is a significant reduction in the activity of iNOS and a rise in the expression of SP-D in lung tissue of different pulmonary aspiration models with curcumin therapy. Conclusion  Our findings support the use of curcumin as a potential therapeutic agent in acute lung injury.